HYPOCHONDRIASIS. 427 



mental and bodily derangement correspond, and do not stand in con 

 tradiction to the psychical peculiarities of the patient prior to his 

 discovery. 



Like all symptoms of mental disease, hypochondriasis proceeds 

 from nutritive derangement of the central organs of all psychical ac- 

 tion, but we are not able to trace back the morbid state of mind, char- 

 acteristic of this malady, to any particular lesion of the brain. We 

 can scarcely ever point out the nutritive disorders of the brain to 

 which the derangements of its functions are due in any other form of 

 insanity, and, in hypochondriasis, it is equally impracticable to trace 

 the causes of the morbid mental condition to cerebral lesion. Where 

 a tendency to the disease exists, it may arise either from psychical or 

 from physical influences. There is no objection to the application of 

 the terms hypochondria sine materia to that form of the affection 

 which proceeds from psychical causes, and hypochondria cum materia 

 to that which arises from physical influences, but the expressions are 

 not to be employed in any other sense. 



The predisposition to hypochondriasis is very slight indeed during 

 childhood, and is far less in females than in males. It is greatest be- 

 tween the ages of twenty and forty. Not unfrequently it is of con- 

 genital origin. In other instances it seems to proceed from debili- 

 tating influences, such as sexual excess, onanism, digestive disorder, 

 or want of fresh air, as well as from an inactive mode of life, or im- 

 moderate self-indulgence, from disappointment, failure of speculations, 

 and an ill-selected career. 



The exciting causes of hypochondriasis are, first, physical diseases. 

 Certain morbid conditions are more liable to cause hypochondriasis 

 than others are, or (to speak more precisely) to produce those mate- 

 rial lesions in the brain which are the cause of hypochondriasis. The 

 principal of these are the gastric affections, especially chronic gastric 

 or intestinal catarrh ; next come diseases of the genitals, and, finally, 

 gonorrhoea and syphilis. In the latter, however, the mental impres- 

 sion made by the disease ought to be taken into account quite as 

 much as its physical effect. If these diseases sufficed of themselves 

 to produce such disorders, the world would be full of hypochondriacs. 

 Regarding them as mere exciting causes, however, only capable of 

 bringing on the disease where a predisposition to it already exists, 

 the disproportion between the frequence of gastric catarrh, of syphilis, 

 or of clap, and that of hypochondriasis, will not appear at all remark- 

 able. 



The operation of mental impressions has a very similar effect. 

 The most important of these consists in the reading of those pernicious 

 books of " popular medicine," innumerable copies of which are in cir 



